Fight The Flu: 4 Ways to Protect Patients

Flu season is upon us again! As we enter the time of year when many of us are at increased risk for sickness, it’s important for ob-gyns and providers to take stock of what we can do to protect ourselves, our patients, and our patients’ families. Now is the time to understand the importance of preventing and treating the flu and learn how best to treat your patients.

It’s always crucial that we protect our patients however possible — but during this time of year, it’s especially important that we protect our pregnant patients, who are at increased risk of severe disease, complications, and hospitalization related to the flu. Those risks are especially compounded for pregnant women with any underlying conditions. As ob-gyns, we’re in a unique position to help drive home the importance of flu vaccinations — and to provide crucial assessment and treatment when need be. In order to best serve our patients during this flu season, we need to be ready to address the issue of the flu from all angles.

So what can ob-gyns do to make sure we’re prepared to protect our patients?

  1. Recommend — and, when feasible, offer — flu vaccination to all patients, particularly those who are pregnant. The flu vaccine is recommended for everyone six months and older.
  2. Lead by example and get vaccinated ourselves
  3. Encourage our colleagues and staff to get vaccinated
  4. Be prepared to assess and treat pregnant patients who present to us with suspected or confirmed influenza

ACOG has prepared resources to help you take these steps. ACOG’s Committee Opinion Number 732: Influenza Vaccination During Pregnancy outlines the recommendations for vaccinating your patients and provides important safety and efficacy information. Committee Opinion Number 753: Assessment and Treatment of Pregnant Women with Suspected or Confirmed Influenza, published this October, features an algorithm that will help providers assess pregnant patients for symptoms of influenza and determine the proper treatment of suspected or confirmed cases. Additionally, ACOG has resources to help you educate your patients on the importance and benefits of getting the flu vaccine and prepare yourself to answer any questions your patients may have about the flu or the flu vaccine.

As providers, we’re responsible for not only doing our best to prevent the risk of contracting the flu but also recognizing flu symptoms, assessing their severity, and prescribing safe and effective antiviral therapy for pregnant women with the flu. With ACOG’s flu resources, providers can make sure they’re prepared to defend against the flu on all fronts. Protect women and their families this flu season by encouraging your patients and staff to get vaccinated against the flu and doing so yourself.

How I Unexpectedly Became A Powerful Voice for Women’s Health

Lynne Coslett-Charlton, MD, is a 2018 ACOG McCain Fellow and practicing gynecologist at Ob-Gyn Associates in Wilkes-Barre, PA. She shares why she’s a passionate advocate for women’s health in the guest blog post below. 

As a young physician in practice, I witnessed the power one person can have—and the impact an entire medical community can make when we speak together. I’m from a small town in Pennsylvania and work as a private-practice ob-gyn in a community hospital near where I grew up. To paint a full picture: I even joined the practice that delivered me some 50 years ago. While my practice provided excellent clinical teaching, it offered little education on the business of medicine. In fact, I was completely unprepared for the realities of the hostile medical liability climate that dominated my early years as an ob-gyn. Malpractice cases in my hometown soared and I was disheartened to see many of my excellent mentors and colleagues forced to alter or quit clinical practice altogether.

The ACOG Pennsylvania Section quickly mobilized in my tiny community, offering ob-gyns like me guidance and support on ways we can use our voice to send a clear message to policy makers. Eventually, malpractice in my community gained national attention and then President George W. Bush’s reelection campaign took notice and added it to his presidential platform.

It was then that I realized the importance of advocating not only for our patients—but for our needs as physicians. I quickly became engaged in my Section’s work on the broad scope of women’s health issues being legislated at both the state and national levels. In May 2018, I had the honor of becoming an ACOG McCain Fellow, which gives ob-gyns like me firsthand exposure to policy development and the legislative process in the federal and state governments.

During my first week on the job, a lot of progress was made on maternal health. First, there was the second annual March for Moms in Washington, D.C., where supporters marched for improved maternal care. ACOG President Dr. Lisa Hollier spoke at the march in support of initiatives like Maternal Mortality Review Committees (MMRC), which provide critical analysis into the causes of maternal mortality. That same week, The Pennsylvania governor signed into law HB 1869, which established Pennsylvania’s first MMRC under the state Department of Health.  MMRCs have since received wide support across party lines—and our message that all states should be consistent on their abilities to evaluate maternal deaths and make recommendations based on expert reviews resonated both at the state and national level. It was voices like ours in the women’s health community that helped maternal health legislation pass with bipartisan support in a political climate where very few issues are considered bipartisan.

It’s revealing when I look back at the road to becoming the strong advocate I am today for women’s health and our profession. When I started my career as an ob-gyn, I didn’t necessarily think of myself as a political force. But we must remember that our patients need us both inside the exam rooms—and outside.

My ACOG Section gave me a platform to make my voice heard and helped facilitate opportunities to meet with my representatives about women’s health issues that mattered to me. ACOG National built on those local experiences and helped me network with like-minded ob-gyns in ways I wouldn’t have been able to otherwise. During my weeks as an ACOG McCain Fellow I not only had the timely opportunity to advocate for MMRCs, but also attended briefings on sex education, sat in on the Advisory Committee Meeting on Women’s Veterans Health, and accompanied ACOG’s Government Relations team to a multitude of political events.

Something I hear often from my peers is “I don’t have time to advocate” or “I’m interested but I just don’t know where to start.” ACOG has so many easy ways for you to be involved—whether its sending out a pre-filled message or comment to your representatives or donating to the ACOG Ob-GynPAC, which is the only federal PAC dedicated to electing representatives who support our specialty. Get started and find your voice by visiting acog.org/advocacy or follow ACOG advocacy on Twitter at @acogaction.

The Case of the 132-Pound Ovarian Tumor

ACOG Member Vaagn Andikyan, MD, a board-certified gynecologic oncologist with the Western Connecticut Health Network (WCHN), and Assistant Professor for the University of Vermont Larner College of Medicine, shares his experience performing a lifesaving surgery on a patient with a 132-pound ovarian tumor in a guest blog post.

When I first saw the patient, she was unable to walk. She had shortness of breath and severe abdominal pain. She was malnourished because what we later learned was a 132-pound ovarian tumor was sitting on her digestive track, making it difficult to hold down food or water.

She sought care when she started to gain about 10-pounds a week. When she was ultimately referred to me, this 38-year-old woman had endured about two months of rapid weight gain. I saw fear in her eyes. I was determined to help her and I knew that I could at Danbury Hospital.

A computed tomography scan revealed a large ovarian mass. I suspected it was a benign mucinous ovarian tumor. The size of the tumor — measuring about three feet in diameter — along with its location made it a life-threatening situation. The tumor occupied the patient’s entire abdomen, and was compressing her aorta and vena cava. I was concerned about an underlining blood clot. The question became how do we remove this tumor and ensure the patient’s safety?

I assembled a team of nearly 25 highly skilled, caring clinical specialists, including fellow ACOG member and gynecologic oncologist Linus T. Chuang, MD, Chairman of Obstetrics and Gynecology for WCHN, plastic surgeon David Goldenberg, MD, Section Chief, Plastic Surgery Subsection at Danbury Hospital, and anesthesiologist Karl Kulikowski, MD, Vice Chairman, Department of Anesthesia, Medical Director, Operating Rooms, Department of Anesthesiology at Danbury Hospital.

Extensive pre-operative planning was crucial because there were many unknowns and hurdles to address. For example, because the tumor was so large, a concern was the amount of excess skin and our ability to close the incision.

We developed and practiced plans for five potential scenarios. Our goal was to perform the tumor resection and abdominal reconstruction at the same time to reduce the number of surgeries for the patient and improve her outcome.

In the end, the surgery took about five hours. We successfully removed the tumor — and only the patient’s left ovary. The patient went home just two weeks later and is expected to make a full recovery.

This was one of the most challenging, complex cases of my career. I might expect to see a 25-pound ovarian tumor, but a 132-pound ovarian tumor is rare. It reminded me how important it is to have colleagues you can rely on and trust. Our ability to pull together our expertise and experience is what gave us the confidence and knowledge-base to tackle this case, especially because this was the first surgery of its kind at Danbury Hospital. Danbury Hospital’s cardiovascular experts were instrumental to ensuring the patient’s safety. Medical residents conducted imperative research to aid in developing the care plan. The operating room staff prepped a room to accommodate a tumor of this magnitude. Dr. Goldenberg removed excess skin that was stretched by the tumor and reconstructed the patient’s abdomen. Danbury Hospital’s Intensive Care Unit and Inpatient Rehabilitation helped the patient to convalesce safely and quickly, and social workers helped the patient and her family to navigate her care plan.

The tumor tissue is currently with WCHN researchers at the Rudy L. Ruggles Biomedical Research Institute. They are conducting genetic tests. We want to understand why the tumor grew so quickly so we and our patient can learn from this case.

This case also reminded me how important it is to participate in community outreach to encourage women to routinely see their primary care providers and gynecologists for wellness screenings.

Thank you for the opportunity to share this extraordinary case with you all.

A Look Back: A Year Spent Advocating for Women’s Health

Throughout my long career as an ob-gyn, I’ve never been witness to a more intense national focus on the health care provided to American women than I have in this past year as president of ACOG. We’ve seen the deaths of pregnant women during and after childbirth take center stage as our understanding of the embarrassing U.S. maternal mortality rate grew. Countless labor and delivery unit closures at rural hospitals across the country have drawn attention to access to care, and many were shocked to learn that nearly half of U.S. counties lack a practicing ob-gyn. Legislative attacks on women’s health care have spread like wildfire, as both federal and state governments have attempted to restrict women’s ability to obtain health coverage and contraception, obstruct their access to abortion care, and institute punitive measures for pregnant women suffering from drug addiction. From the beginning, it was clear that the challenges facing our specialty—and to us, the physicians who care for women throughout their lifespan—are immense.

Before I officially took the reins in May 2017, we were already in the midst of the work, advocating against efforts in Congress to strip health care from millions of women through the repeal of the Affordable Care Act (ACA). Women stood to lose access to no-copay contraception, affordable maternity care, and essential preventive services. Women were at risk of returning to a time where they might have been denied coverage based on a prior C-section or had to pay more for insurance based on their gender, and Medicaid coverage for hundreds of thousands of low-income women would have been in jeopardy.

All of this played out in the news as ACOG fought fiercely alongside five other provider organizations in a coalition called the Group of 6. We batted down every iteration of legislation that would have been detrimental to the health of the women in this country. We lobbied, we rallied, we spoke to the media, and we galvanized ACOG members in support of this common cause. I am proud of what we accomplished, and I count the tremendous effort to defeat ACA repeal as one of the successes of my presidency. But, of course, there was much more work to be done.

In addition to my time at ACOG, a large focus in my career has been on perinatal health disparities and maternal mortality. More than 60 percent of maternal deaths are preventable, and more than 65 percent occur within the first week postpartum. One way ACOG is trying to address this is through the Preventing the Maternal Deaths Act. It would provide grant funding to states to establish or bolster maternal mortality reviews committees tasked with studying the causes of these deaths, and how they can be prevented. But these statistics also indicate that as providers, we need to change the paradigm when it comes to postpartum care.

As part of my presidential task force, “Redefining the Postpartum Visit,” we began with the premise that postpartum care is the gateway to lifelong health. It is not sufficient for women to have one visit six weeks after childbirth. It is critical for women to be seen within the first three weeks and then on an ongoing basis as needed—up to 12 weeks—to address several issues, including breastfeeding complications, postpartum depression, and chronic conditions such as diabetes and heart disease that often persist long after pregnancy. Women have multiple intersecting health needs, so we must facilitate care coordination between multiple providers to ensure women are able to seamlessly access the support and care they need. The task force just released a Committee Opinion this week and, in the coming months, a companion online toolkit for providers will be developed to assist in providing more holistic care. The latest article from ProPublica outlines how this reinvention of postpartum care will require “sweeping” changes in medical practice and throughout the maternal care system if we are to truly optimize the health of moms.

Another focus of my presidency has been on innovation in technology to improve women’s health, particularly telehealth and telemedicine. According to a Health Affairs study, nine percent of rural counties experienced the loss of all hospital obstetric services between 2004 and 2014. Through my “Telehealth Task Force,” we have been working to develop best practices in ob-gyn to improve access and address fragmentation in care. This has significant implications for the Levels of Maternal Care initiative, which focuses specifically on care access in rural settings. It relies on communication and care coordination between hospitals and birthing centers so that women can be transferred to and receive care from a facility that offers the level of care that best suits their needs. Telemedicine will be key in fostering that communication.

The task force remains committed to addressing issues regarding safety, payment, experimental e-obstetrics, virtual education, video conferencing, virtual monitoring, apps, and the crossover between inpatient and outpatient care. In the future, a telehealth Committee Opinion will be developed, and an ongoing work group will be established to continue this important effort. We are also combating the access issue from a legislative perspective through the Improving Access to Maternity Care Act. It has been passed in the House and currently resides in the Senate. Through this legislation, an official maternal health designation through the Health Resources and Services Administration will be created to better determine shortage areas. This in turn will allow more providers to serve in these areas through loan forgiveness programs and scholarships offered by the National Health Service Corps.

However, in our efforts to improve care on a systematic basis, we must not forget how critical it is to address implicit biases that permeate every aspect of care delivery and contribute to the racial health disparities that have led to our high maternal mortality rate. An often-repeated statistic, is that black women in the United States are three or four times more likely to die during childbirth than white women. It is shocking to most, but it shouldn’t be. Racial health disparities have a long history, and events as recent as what happened in Charlottesville last year remind us we still have a long way to go.

Even when black women have access to health care and advanced education, they are still at a disadvantage when it comes to receiving the quality of care on par with their white counterparts, and the constant stressors of racism and racial biases often put them at higher risk for chronic health conditions. Cardiovascular disease disproportionately affects black women, and stress has been linked as a possible contributor. I have been working with Dr. Lisa Hollier, ACOG’s incoming president, to partner on initiatives with the American Heart Association to address issues with women and cardiovascular disease, and I am confident that she will make marked improvements in this area.

It has been a whirlwind. I have traveled the country and the world in pursuit of advancing women’s health and ensuring that the clock is not turned back. I have worked alongside ACOG leadership and Fellows, including my esteemed colleagues, Drs. Hollier and Gellhaus, to improve maternal health for all women in the United States and serve as a model for women’s health care throughout the world. It has been a rewarding journey, and we have made incredible progress, but I am ready to pass the torch, and wish Dr. Hollier success as she carries it forward—there is much more work to be done, and I look forward to working with her this year as immediate past president.

For Ob-Gyns, Zika is Still News

Around this time last year, the Zika epidemic was covered by every major news outlet across the country and ACOG issued a statement reaffirming the latest warning from the U.S. Centers for Disease Control and Prevention (CDC) advising pregnant women not to travel to a specific area in Miami, Florida. We had recently learned that it was possible for the virus to be transmitted during all trimesters of pregnancy and ob-gyns were actively advising pregnant patients and their partners who had lived or traveled to Zika-affected areas to use contraception or abstain from sex for the duration of the pregnancy. While it was critical to get information out as soon as possible, we acknowledged that there were still many unknowns regarding transmission and the various harmful birth defects that can result from an infected fetus. During that time, we joined the CDC in recommending that all pregnant women be assessed for possible exposure at each prenatal care visit and that pregnant women with exposure be tested regardless of symptom status.

Since that time, the amount of data we have on Zika has increased and the realities regarding transmission of the virus have changed. For one, we’ve learned that the Zika virus antibodies can persist for months in some pregnant women, which makes it difficult for providers to know with certainty whether infection occurred before or during pregnancy. And, overall, the number of people infected with the virus in the United States and U.S. territories such as Puerto Rico has declined since 2016, making false-positives more likely when there is a lower occurrence of the disease. Therefore, the CDC, working with ACOG, announced at the end of July new guidance for pregnant women with possible Zika exposure. One of the significant changes is that we no longer recommend routine testing of pregnant women who are not experiencing symptoms and do not have ongoing exposure. In addition, to help address known issues with available Zika tests, pregnant women who are tested should receive concurrent IgM and NAT testing. ACOG continues to update a Practice Advisory, which further explains these changes and several others, as well as the new focus on shared decision-making when it comes to screening and testing patients, particularly those who are not experiencing symptoms.

While these new recommendations reflect the best data available on the virus to date, educating providers in a climate with rapidly changing recommendations remains challenging. It is certainly good news that the spread of the virus is on the decline in some areas, but Zika still poses a very real threat and we must remain vigilant. There is already a lot to cover at each prenatal care visit, but screening for Zika virus must continue to be a priority. Additionally, education about family planning for women who do not wish to become pregnant and condom use for pregnant women and their partners at risk of exposure are still essential. We can’t forget that contraception is an important tool in our fight against birth defects caused by Zika.

Also, adequate funding for needed resources to better understand and combat Zika are still a necessity. We need to be able to continue to track the virus through tools like the U.S. Zika Pregnancy Registry, deepen our understanding of its impact on pregnant women and fetuses, simplify and improve Zika virus testing and develop an effective vaccine. We must also remember that continued funding for Medicaid expansion and coverage of essential health benefits increases access to maternity, preventive and primary care for women at risk for the virus.

So, while Zika headlines might not be as prevalent anymore, we have a responsibility as physicians to keep it top-of-mind because there is still much work to be done.

To access ACOG’s Zika resources, visit https://www.acog.org/About-ACOG/ACOG-Departments/Zika-Virus.

Guest Blog: Hurricane Harvey Has Shown the Resilience of My Community

Over the past few days, I’ve seen up close and personal the catastrophic damage Hurricane Harvey has caused Texas and our patients.  In my role with Texas Children’s, I’ve worked with our team to coordinate disaster and recovery operations across our system of hospitals, out-patient clinics and our health plan.  Yesterday, when on-site to evaluate damage at one of our closed clinics, a pregnant mom drove up with her sick daughter, and my co-CMO and I were able to remove the sandbags, access our clinic, and provide urgent care to this frightened family.

The need is great. The scale of flooding is just disastrous, but I have been heartened to witness the resilience of my community and the immediate urge to help from across America.

As one individual on the front lines of this catastrophe, and on behalf of ACOG leadership, thanks to each of you for your outpouring of concern, thoughts, prayers, and offers to assist in any way you can.  We also extend our sincerest gratitude to federal, state and local workers and volunteers whose heroic efforts are saving lives in Texas and on the Gulf Coast.

Our work in Houston and along our Texas Gulf Coast is very far from done.  Recovery will take years of work and mountains of resources.  While ACOG is not a disaster relief organization, nor can we vet relief organizations, those of you who want to help can find options on the State of Texas Emergency Website.
 

Thank you, sincerely, for your concern and for your dedication to your patients.

Lisa Hollier, M.D., ACOG President-Elect

A Rewarding Journey as ACOG’s President

When I started my term as ACOG’s 67th president last May, I wanted to make a difference in the lives of our members and patients, ensure ACOG’s continued growth, and lift our voice as the leading specialty organization in the nation. In many ways, what we have accomplished in 12 short months has far surpassed my expectations given the complexity of the issues we’ve had to deal with and the extraordinary circumstances we’ve had to navigate and overcome. So, in my last month, I’d like to revisit some of the things that have made this such an impactful year and taken me around the globe.

When I initially laid out my priorities for advocacy and global women’s health, there was no way to know the challenges we would face to protect women’s continued access to reproductive and maternal health care, both domestically and abroad. As my tenure progressed and new challenges presented themselves, increased member engagement became even more essential. So, we leveraged my All-in for Advocacy campaign, an effort to amplify and expand our voice with state and federal policy makers through our member stakeholders. In 2016 and 2017, I traveled throughout the country doing presentations at Grand Rounds and participating in state lobby days and was wowed by the energy and eagerness of our advocates to make positive changes in their home states.  Physicians led efforts to support our patients and our practices, successfully advancing legislation from maternal mortality to Zika and defeating legislation affecting the sacred patient-physician relationship and restricting reproductive health rights.

Also, because of ACOG’s excellent government relations team, we launched the State Legislative Action Center, where ob-gyns are able to learn more about their legislature and elected officials, search active legislation, and find opportunities to take action. And this certainly was the year for action! Ob-gyns had an important voice in the discussions on health care reform and urged policy makers not to turn back the clock on women’s health by repealing the Affordable Care Act. We fought for our patients to have continued access to affordable insurance coverage, comprehensive maternity care, no-cost preventive services such as contraceptives, and consumer protections that would prohibit insurers from denying coverage based on pre-existing conditions or setting annual or lifetime benefit caps. And while the fight is not over, the defeat of the American Health Care Act this past March is evidence that we made a tremendous impact.

We have also made great strides in ACOG’s efforts overseas. Through my own personal work to advance health care in struggling countries, I learned that we as ob-gyns can make a difference in global women’s health by sharing our knowledge and resources. However, extended time away from one’s practice is always very difficult and, for some, next to impossible. One of my goals was to make short-term projects easily accessible and identifiable for ACOG members and I am proud to say that we developed a database of non-profit organizations involved in two-week mission work that allows ob-gyns to get more information and sign up.

We’ve also grown the Alliance for Innovation in Maternal Health (AIM), which creates instructional and educational portfolios, or “safety bundles,” to fight high rates of maternal mortality in the United States. Through the hard work of ACOG’s Office of Global Women’s Health, the AIM safety bundle for postpartum hemorrhage has been instituted into practice in a low resource setting in Malawi at a community health clinic and referral hospital.  And it has meant so much to me to see the progress made and the lives saved because of this initiative. Additionally, ACOG helps educate and train local health providers in underdeveloped countries in various areas of obstetrics and gynecology through several programs, including Health Volunteers Overseas. I’m particularly proud of this work because I firmly believe that the same high standards we have for health care in the United States are the same standards that should apply to other developing countries around the world.

Lastly, another one of my goals this past year was to continue efforts to address the workforce and practice pattern changes we’ve seen in our specialty by improving ob-gyn resident education models. In 2016, the Council on Resident Education in Obstetrics and Gynecology Education Committee embarked on a complete overhaul of the learning objectives for residents. This effort resulted in the release of the Educational Objectives: Core Curriculum in Obstetrics and Gynecology, 11th edition. We are now surveying mid-career practicing ob-gyns to determine which of the core objectives they actually apply in their practices. Although this was an issue without an easy solution, we must continue to work together and discover ways to improve. And I truly appreciate all the hard work of ACOG’s education staff in helping to facilitate this endeavor.

As I pen my last blog, I feel that my time from president-elect nominee to president has been an incredibly rewarding journey that has literally spanned 400,000 miles, according to my frequent flier program. From trips to the nation’s capital to residencies across the country to small community health centers in Africa, each experience taught me so much and it was a great honor to be able to serve ACOG’s members in the process. If I had to impart any advice to ACOG’s incoming president, Dr. Haywood Brown, it would be to enjoy it because it will fly by. (No pun intended.) Enjoy the year, enjoy the people, and listen to their stories. Everyone has a story!

Conversations with Pregnant Patients Should Include Discussions About Infant Immunization Plans

This week is National Infant Immunization Week (NIIW), a time devoted to promoting the benefits of vaccination and to improve the health of children two years old or younger. As ob-gyns our active role in a baby’s health care often ends once a mother is discharged following delivery, but we play an important role in preparing women to tend to their infant child’s needs, including planning for immunization.

Pregnant women and infants are among the most vulnerable during infectious disease outbreaks. I’ve written before about ob-gyns responsibility to educate women about getting vaccinated during pregnancy, underscoring that immunization is essential to the health of both mother and fetus. Building women’s awareness about the importance of immunization during pregnancy also opens the door to discuss the importance of continuing immunization efforts into infancy and onward.

The positive outcomes associated with immunizing infants cannot be overstated. Though it’s hard for many to recall, there was a time where many infants and young children faced high risk of life threatening and debilitating illnesses. Many of these, like measles and polio, have been greatly reduced, almost eliminated due to population wide vaccination. We can protect children under the age of two from 14 different diseases, which is estimated to prevent 20 million cases of disease and about 42,000 deaths. While we should be heartened by these positive numbers, the key to keeping these infectious diseases at bay is ensuring parents understand that vaccination is safe and essential to the health of every child.

NIIW is a great time to renew efforts to educate patients about vaccine preventable diseases, and the positive impact vaccination has on all our lives. To make following immunization guidelines as straight forward as possible, ACOG has compiled all our immunization guidelines on one page, available here. Additionally, during a woman’s pregnancy, ob-gyns should encourage thinking about and planning for the infant’s health care. We can help by making referrals to pediatricians and directing women to resources that outline an infant’s necessary care, including immunization. The CDC prepares immunization schedules by age as a quick and helpful resource for providers, and childhood immunization schedule generators for parents, from age 0 to 6.

We are fortunate to live in a time where vaccination protects from some of history’s most devastating infectious diseases. We must continue to educate and support patients’ understanding about the overwhelming benefits of immunization for themselves and their children.

 

This Earth Day be a Champion for Environmental Science

Did you know that doctors are among the most trusted professionals in this country, specifically with regard to information about climate change? Environmental factors are hurting the health of millions of Americans every day and yet there is still a considerable lack of awareness about the harmful effects of things like extreme weather events, air pollution and other toxins.

As Earth Day approaches, it seems fitting that this year’s campaign is focused on environmental and climate literacy because it reminds us as ob-gyns how important it is for us to participate in the effort by leveraging the trust our patients have in us.  Our partner organization, the International Federation of Gynecology and Obstetrics, has kicked off the week by launching a social media awareness campaign around Earth Day.  You can follow them on Twitter under the handle @FIGOHQ.

Last month, I spoke at the launch of the Medical Society Consortium on Climate Change and Health that has brought together ten associations representing nearly 500,000 physicians, including ACOG, to help increase awareness among the public and policymakers about the negative health effects of climate change on Americans. During my talk, I spoke about the fact that women face some of the greatest risks from climate change over the course of their lives, and especially during pregnancy. In affected regions, climate change puts women at risk of disease, malnutrition, poor mental health, lack of reproductive control, and even death. Additionally, women’s exposure to toxic environmental agents during the preconception and prenatal stages can have a profound and lasting effect on obstetrical and later life outcomes, including increased risk of birth defects and childhood cancer.

In 2016, ACOG adopted a policy which recognizes that climate change is an urgent women’s health concern and a major public health challenge endangering fetal health. In fact, we discover new evidence every day of how it can disturb fetal development. A recent NIH study found that exposure to extreme hot and cold temperatures during pregnancy leads to increased risk of low birth weight in infants.

While the connection between climate change and women’s health may not at first seem obvious, there are a number of ways it directly impacts women’s health.  You can look at them in several categories: a healthy pregnancy starts with clean air, clean water, no toxic chemicals, and stable climate.

Air pollution poses serious risks for women’s health.  It is linked to pregnancy loss, low birth weight babies, and preterm delivery.  Fine particle air pollution affects the placenta in pregnancy, and can interfere with fetal brain development.  Ambient and household air pollution result in 7 million deaths globally per year; these effects are worse in low-resource areas.

Heavy downpours and flooding mixed with high temperatures can spread bacteria, viruses, and chemicals that lead to contaminated food and water. This results in higher levels of methylmercury in fish and shellfish, a known cause of birth defects.

Increased use of pesticides can interfere with the developmental stages of female reproductive functions, including puberty, menstruation and ovulation, menopause, fertility, and the ability to reproduce multiple offspring. These toxic exposures also affect fetal brain development, and contribute to learning, behavioral, or intellectual impairment, as well as neurodevelopmental disorders such as ADHD and autism spectrum disorder.

Extreme temperatures have fostered increases in the number and geographic range of insects. For example, Zika-carrying mosquitos have led to more than 1,500 infections in pregnant women across the United States and District of Columbia, and more than 3,200 infections in Puerto Rico and U.S. territories. Furthermore, extreme heat during pregnancy is tied to a 31 percent increase in low birthweight babies less than 5.5 pounds.

Unfortunately, in many cases, underserved and vulnerable populations are disproportionately affected by climate change. This includes individuals living in poverty, exposed to toxic materials via their occupation, who lack nutritious food, and live in low quality housing. That’s why access to health care is so critical.

We don’t all have to be experts in environmental science, but we all need to support rigorous scientific investigation into the effects of climate change and toxic environmental agents. With evidence to support us, ob-gyns must be the authoritative voice and help to ensure that the discussion on climate change includes protecting the health and safety of all women and children.

This blog post was co-authored by Nathaniel DeNicola, MD, MSHP, the ACOG liaison to the American Academy of Pediatrics Executive Council on Environmental Health, and social media director for the International Federation of Gynecology and Obstetrics Working Group on Reproductive and Developmental Environmental Health.

Four Ways ACOG Has Impacted Global Women’s Health in Just the Past Year

In 1994, my wife and I arrived for our first two-week mission in the Dominican Republic and were stunned by the line of people waiting outside of the hospital for us. Since medical school more than a decade earlier, we had dreamed of participating in mission projects around the world to help women in dire need of basic medical care. But then my wife began her career as a nurse, we started our family, and after residency I went into private practice. So, that goal went by the wayside. However, our trip to the Dominican Republic quickly reignited our hopes of providing necessary ob-gyn services in low resource settings. Living in the United States, it’s easy to forget that many countries around the world are battling poverty and disease and don’t have the same infrastructure and safety nets we do. After that first trip, I came home to a fully equipped operating room with the proper tools and lights that worked, my wife didn’t have to hold a flashlight during surgery because the power was out. We had carpeting and hot water at home. From that point on, my eyes were opened.

Since that first trip, I’ve continued to travel and offer my services to advance health care in struggling countries. This work has taught me that we can really make a difference in global women’s health by sharing our knowledge and resources as ob-gyns. As my presidential term at ACOG comes to a close, it is an appropriate time to reflect on what we have accomplished from my six-point plan, developed over a year ago, to help improve the health of women and children worldwide, with a focus on training and providing health care around the world.

The first step was to make these kinds of missions more easily identified and attainable. While it’s often not realistic to leave your practice for months; two weeks is doable. That’s why we developed a listing or database of non-profit organizations involved in two-week mission work in which some of our members had participated. Now on the ACOG website there is a global health resource center. ACOG members can discover more information about each organization, check these organizations’ calendars for potential projects, talk with ACOG fellows and junior fellows who have done projects, and sign up. And we must continue to get the word out so more members use and add to the database.

In partnership with the U.S. Department of Health and Human Services, we’ve also formed and grown the Alliance for Innovation in Maternal Health (AIM), which creates instructional and educational portfolios, or “safety bundles,” to fight high rates of maternal mortality in the United States and now Malawi. Women living in rural areas of Malawi give birth at community health centers that can’t perform operative vaginal deliveries or C-sections. When these situations arise or other complications occur, women are transferred to the central hospital in the city, most often without any attempts at stabilization prior to transport. They are often in poor condition when they arrive, which results in many otherwise preventable maternal deaths. The AIM postpartum hemorrhage bundle has been instituted into practice at both the community health clinic and referral hospital. To date, more than 130 local people have participated in vital simulations to help these patients. And while we do not have formal data on the program yet, we know that several women have received life-saving care because the teams were able to communicate and execute care in a way that they didn’t before. We anticipate many more successes that will hopefully mirror the kinds of gains we have seen here in the United States.

In addition, last year ACOG partnered with Health Volunteers Overseas, a nonprofit group that helps educate and train local health providers in underdeveloped countries in various areas of obstetrics and gynecology. It begins with local providers telling us what they need and then we come up with a plan and work together to make it happen. As of today, we have completed four site assessments and will begin offering global service opportunities for fellows in the four countries by May 2017.

Lastly, in Ethiopia, we received a five-year grant to develop a plan in partnership with the Ethiopian Society of Obstetricians and Gynecologists to strengthen their ob-gyn residency training programs and curriculum, improve continuing medical education, support the publishing and accessibility of clinical outcomes research, and develop an ob-gyn examination and certification program. Since its inception, the program has made great strides by working “shoulder-to-shoulder” with the Ethiopians. As a result of this program, there is now interest from other African countries to begin the same program.

The bottom line is, many women around the world are lacking access to quality, evidence-based health care and they are paying the price with their lives. As ob-gyns, we have the power to prevent this by using our skills to help reduce global maternal morbidity and mortality, as well as improved quality of life. These programs are a prime example of how we can achieve that by dedicating some of our time and effort to a cause that is greater than ourselves. While we’ve accomplished a lot, we still have much to do. So, even if you aren’t sure you have the time, consider any way you can contribute. Believe me, it will make a difference.